Friday, November 23, 2012

Mammograms Ineffective In Detecting Breast Cancers

Annals of Medicine

An article in The National Post says that mammograms are not as effective in screening for breast cancer as its advocates initially thought.
Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate. Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don’t need treatment, the study suggests.
It’s the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.
But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call “cancer” are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don’t really need.
Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it’s relatively new to the debate over breast cancer screening. “We’re coming to learn that some cancers — many cancers, depending on the organ — weren’t destined to cause death,” said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, “once a woman is diagnosed, it’s hard to say treatment is not necessary.”
Even if she doesn't have a malignant tumor? What this also says is that suspicious and abnormal "lumps" do  not necessarily equate to a malignant cancer. Many women—the study says up to one-third— undergo stressful and unnecessary follow-up biopsies, and in some cases treatments, as a result of false mammogram interpretations.

Yet, like all such new and controversial findings, it's not conclusive; not all cancer specialists are nodding their heads in agreement and confirming the finding. As the article adds:
Dr. Len Lichtenfeld, the cancer society’s deputy chief medical officer, said the study should not be taken as “a referendum on mammography,” and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it’s not possible to tell an individual woman whether her cancer needs treated.

Perhaps so, but the good doctor admitted that overdiagnosis is a problem. What can one conclude, then? The study's author's noted: “We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening.” What this finding shows is that medicine and its many practioners now need to come up with better guidelines on how to clearly define cancer and treat it. There has to be some agreement on approach.

What also needs greater attention is training physicians to take greater responsibility for their actions, to understand that it is humans they are treating and not symptoms or diseases. Although this issue has been raised countless times over the last few decades, including in the mass culture of film and TV, it needs further action, or attention. There has been too little attention paid to the emotional effect of delivering false results to individuals.

You can read the rest of the article at [National Post]

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